What Are Medical Billing and Coding? Explanation, Uses, and Differences
What Is Medical Coding?
Medical coding is the process of translating descriptions of medical diagnoses, procedures, services, and equipment from patient records into universal alphanumeric codes using standardized classification systems such as ICD-10, CPT, and HCPCS Level II.
These codes provide a universal language for the efficient and accurate communication of complex medical information among healthcare providers, insurance companies (payers), and government agencies.
According to AAPC (American Academy of Professional Coders), medical coding plays a vital role in ensuring accurate claim submission and proper payment for healthcare services.
Reference: AAPC – What Is Medical Coding?
What Is Medical Billing?
Medical billing is the process of using these codes to generate and submit insurance claims and patient bills to receive payment for services rendered by a healthcare provider.
Medical billers track claims, follow up with insurance companies about unpaid or denied claims, manage accounts receivable, and communicate with patients regarding their balances.
What Does a Medical Biller Do?
Medical billers follow up on claims to ensure that healthcare providers receive proper reimbursement for their services. They handle several important tasks, including:
- Collecting patient information
- Verifying insurance coverage
- Securing prior authorizations
- Managing payments
Overall, medical coders and billers work closely together to ensure:
- Accurate documentation
- Proper billing
- Smooth financial workflow in healthcare practices
What Does a Medical Coder Do?
Medical coders review medical reports and apply codes from classification systems like CPT (Current Procedural Terminology), ICD-10-CM (International Classification of Diseases), and HCPCS Level II (Healthcare Common Procedure Coding System) to summarize the medical services provided.
What Are the Key Differences Between Medical Billing and Coding?
| Aspect | Medical Coding | Medical Billing |
|---|---|---|
| Primary Goal | To translate medical documentation into standardized codes for consistent data and billing. | To pursue payment from insurance companies and patients for services provided. |
| Main Tasks | Reviewing patient records, extracting billable information, and assigning the correct codes. | Preparing and submitting claims, tracking payments, managing denials and appeals, and handling patient inquiries. |
| Interaction | Generally works behind the scenes with medical records and physicians for clarification; typically less patient interaction. | Involves frequent communication with insurance companies, other staff, and sometimes patients regarding bills and payments. |
| Skills | Strong knowledge of medical terminology, anatomy, physiology, and coding guidelines; high attention to detail and analytical skills. | Knowledge of insurance policies, reimbursement methodologies, and billing software; strong problem-solving and communication skills. |
Why Are Medical Billing and Coding Important in Healthcare?
Learn More About CPT, HCPCS, and J-Codes in Medical Billing
For more detailed insights into specific CPT codes, HCPCS codes, and J-codes used in medical billing and coding, explore the following articles:
- CPT Codes 99211–99212–99213–99214 and 99215
- What Are J-Codes for Medications?
- CPT Codes 99202–99205
- CPT Code 99211 Explained
- What Are J-Codes in Medical Billing?
- What Is HCPCS?
- CPT Code 11900 – Injection into Lesions
- CPT Code 97810 – Acupuncture, Initial 15 Minutes
- CPT Code 73721 – MRI of Lower Extremity
- CPT Code 20692 – Application of Multiplane External Fixation
- Pathology CPT Codes for Surgical Procedures
- CPT Codes for Therapeutic Phlebotomy
- CPT Code 99213 – Office or Other Outpatient Visit
- Modifiers in CPT Coding
- What Are CPT Codes?
- Evaluation and Management in Medical Billing
- CPT Codes for Urgent Care
- CPT Codes for Colonoscopy
- CPT Codes for Echocardiogram
Conclusion
Medical billing and coding play a vital role in the healthcare system by ensuring that medical services are properly documented, coded, and reimbursed. While medical coders focus on accurately translating patient diagnoses and procedures into standardized codes, medical billers use those codes to process claims and secure payments from insurance providers and patients.
Together, these two functions form the backbone of the healthcare revenue cycle—supporting financial stability, compliance, and accurate patient record-keeping. Understanding the differences, uses, and importance of medical billing and coding helps both professionals and healthcare organizations improve efficiency and maintain transparency in patient care.
As the healthcare industry continues to evolve in 2026 and beyond, skilled billing and coding professionals will remain essential for accurate data management, timely reimbursement, and high-quality patient services.
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